Provider Demographics
NPI:1316179963
Name:SHENANDOAH TX ENDOSCOPY ASC LLC
Entity Type:Organization
Organization Name:SHENANDOAH TX ENDOSCOPY ASC LLC
Other - Org Name:WOODLANDS ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:20 BURTON HILLS BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-6197
Mailing Address - Country:US
Mailing Address - Phone:615-240-3720
Mailing Address - Fax:615-234-1720
Practice Address - Street 1:111 VISION PARK BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3002
Practice Address - Country:US
Practice Address - Phone:936-321-8910
Practice Address - Fax:936-321-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-17
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L22271OtherCRNA SANDRA LENHART
TX8F33700OtherCRNA JULIA MARTIN
TX8L25451OtherCRNA GLYNN COOPER
TX8L26184OtherCRNA JAMES BODOH
8L21238OtherCRNA ROTH OWEN
TX8L22350OtherCRNA JAMES MATTINGLY
TX8F33699OtherCRNA ESTHER SCOGGIN
TX8F33701OtherCRNA DUANE RIEGEL
TX8F33698OtherCRNA DANA FISHER
TX8L22270OtherCRNA BRENDA MCCALL
TX8L22350OtherCRNA JAMES MATTINGLY